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Doctors don’t cry

Today I broke the rules. I held my patient’s hand and I cried with her.

That’s completely ‘unprofessional’ behaviour.

In fact it’s so taboo for doctors to show emotions in front of their patients that the image doesn’t even exist in the commercial photo banks. I couldn’t find a single stock image to illustrate this article. The photo I used is not of a doctor.

Why did I cry? I was called to anaesthetise a patient for a C-section when she had just found out her baby was dead.

The day before, she came to the pre-op clinic to plan her anaesthesia and surgery for an elective C-section. She’d reached full term in a healthy pregnancy. There was no hint of the impending catastrophe. At the anaesthesia clinic the patient said she was a little worried because her baby hadn’t been moving so much. As a precaution, the anaesthetist asked the midwife to do a quick scan while she was at the clinic. There was no heartbeat.

In 29 years of practice, I have never before given anaesthesia for C-section in a mother who is carrying a dead baby. Stillbirths usually occur earlier in pregnancy when the baby is smaller and a vaginal delivery is the safer option. I had to think really hard about how to give a safe anaesthetic and my goals for the patient.

Having a C-section under spinal anaesthesia is not a pleasant experience, even though the event may be joyful. There are many side effects and discomforts, even with the best anaesthesia. I didn’t think my patient would be able to tolerate the surgery awake when she was already profoundly distressed. At the same time, I didn’t think being sedated with doses of morphine post-op was a great way to be with her newly born baby while beginning her process of grieving. So I thought that doing a spinal anaesthetic as already planned, plus a general anaesthetic for the duration of the surgery, would allow her to be alert and pain free after the surgery but would save her from having to endure the procedure itself.

With my clinical thinking done, my more important task was to consider how I might best support this patient, her husband and the family, who were all shocked and grieving. In times past, I would have felt embarrassed and inadequate: doctors don’t deal well with death. I would probably have retreated to a place of clinical detachment. Now I know better. I allowed myself to have feelings. I allowed myself to feel deeply sad at the sudden and unexpected loss of this baby and the suffering of the parents. I was not overwhelmed by these feelings and they did not impair my judgment or my care; they were humanly fitting to the situation – except in the world of medicine where objectivity and professionalism are the unbroken rule.

I shared my feelings with the patient. After taking care with introductions, and making sure I brought a spirit of gentleness and compassion into the room, I asked the patient permission to sit on the bed with her. I held her hand and told her how sorry I was to hear her news, how devastating this must be for her, and how sad I felt. We shared tears.

I didn’t propose a plan for anaesthesia. I shared with her my thinking that the grieving process was very important: that the first few hours after her baby was born, when she got to hold her little girl and speak to her, were really important. I said that I thought it was important for her to be pain-free and alert during those hours but I also didn’t want her to endure any discomfort during the surgery itself. A possible solution, I said, was to combine a spinal and general anaesthetic. At that point she burst into tears and I wondered if I had said something wrong. It turned out they were tears of relief. She was dreading the prospect of being awake during the surgery and was intensely relieved to hear my suggestion that she could have a general anaesthetic during the procedure.

We quietly talked through all the details of care and how her husband could be involved. At the end of the consultation I asked her if would be OK to give her a hug. She held tightly onto me.

Everyone in the OR was kind, sensitive and compassionate and the procedure went well. Both the patient and her husband remained calm. A perfect baby girl was delivered, lifeless, and we all felt deeply saddened. The hospital Chaplain came to do a blessing and the OR staff were sent home early, before the end of their shift. I was relieved of my duties for the rest of the day.

The next day, I was busy in the OR and I didn’t have time to visit my patient. But I was really touched when no fewer than three staff members sought me out to convey messages from my patient that she was very grateful for my sensitivity and caring.

I saw her at the end of the day and we parted with a kiss; there didn’t seem any other way to express the intimacy of our encounter. Our lives had touched and I think we’ll both always remember that day.

I became a doctor because I wanted to be a healer; I wanted to be alongside people in their crises, to offer compassion and understanding, and help them to transcend their suffering. But modern medicine doesn’t acknowledge the amazing human capacity for healing. To call yourself a ‘healer’ is to invite professional censure and ridicule.

As we travel around the world we hear many stories of health professionals who have this same ache in their heart: a deep desire to treat people with compassion and healing but a healthcare system that dehumanises both patients and professionals.

At this point in my career I don’t care much for the rules any more. I’ve been campaigning for ten years to bring more compassion and humanity into healthcare and I choose my own way of being, even if it is ‘unprofessional’. I know in my heart that the emotional connection I have with patients is what sustains me and makes me a better doctor.

But if the culture of medicine and healthcare is to change we need more people who are willing to break the rules. Will you cry with your patient?

31 Responses to “Doctors don’t cry”

As a medically-retired physician, I read your post with joy. If only there were more doctors with the courage to openly share emotional connections with patients. With care it need not be unprofessional. Do take care of yourself to avoid the burnout which is a danger of such compassion. Thanks for sharing.

Thanks for your kind words, Alison, but I take issue with one of your comments. It comes down to the difference between empathy and compassion. If doctors have empathy alone, they risk burnout because they feel the pain and suffering of the patient, experience negative affect and an aversive experience. But when an attitude of loving kindness and a motivation to relieve the patients’ suffering is added to empathy, it transforms to compassion. Neuroscientist Tania Singer has shown that during compassion, completely different brain circuits become active – those associated with positive affect and human affiliation and bonding. The negative emotion becomes a positive one. We have informally researched the characteristics of health professionals who are joyful and flourishing in challenging work environments where many people are burning out. What distinguishes them is deep compassion and a love for their work.

Beautiful, just beautiful! We are all human and to have such a compassionate outlook is refreshing. What a wonderful quality to possess as a doctor. They aren’t robots and should never hide normal human emotion! Well done!

Hopefully things are changing for the better
Why is it so wrong to act like a human being?
Your story reminds me of two other women who appreciated care by a humane obstetrician
Woman 1 arrived at 39 weeks of pregnancy with an intrauterine death. Her primary caregiver basically ran for the hills and didn’t even come and visit her. Boy did that make me angry so I went out of my way to spend time and make sure she had the best of care. Often just holding her hand. I ended up delivering her next 3 children and felt privileged to be able to do so along with the tears of joy each time the newborn let out its first cry.
The other woman illustrates how humane the patient can be. Woman arrived in early labour Heart rate recording was unusual I was heavily pregnant about 35 weeks myself.
Scanning revealed a fading fatal heart beat. We screamed down the corridor to theatre as fast as was possible Unfortunately the baby was not able to be resuscitated.
Every time I visited her she managed to get in How are you before I could ask her!
Amongst her profound grief she was still concerned that myself and my baby were ok recognising I think that I had temporarily forgotten that I was so pregnant in an effort to save her child
Yes there were tears and hugs as well. Who wouldn’t have cried in the circumstances !

It’s a sad story Robin and very moving.
Yes, you were compassionate. Yes, you were empathetic and yes you were professional.

What stood out above anything though, for me, is that you were authentic. You were being yourself and that gave your patient full permission to relax (as much as possible under the circumstances) and be herself.

It’s sad when being authentic seems to mean being unprofessional. Because that also means that to be professional you have to be fake. No wonder staff in hospitals are so stressed when they’re required as part of their role be fake. A sad story indeed.

This is so important Robin, I used to get into trouble for crying with patients, and for being close to them and forming bonds. But like you, I don’t care for rules and regulations that try to make us into feelingless robots, separated from our human emotions. Thank you for all you do – you are a shining star.

When we train massage therapists to work mindfully with folk on the edge of life we discuss ‘ethics’ at length. Often the oncology massage professional is the only person offering safe touch to a ‘wounded’ body and soul. In the training programs we follow all the hospital approved teaching and insure that it is fully understood. Then life happens…sometime later I field calls… ‘I just had to hug the patient’ or ‘I just had to accept the gift’, followed by ‘I just cannot stop crying’. They tell me about the guilt of not remaining detached. A health care system that substitutes guilt for compassion? When we connect intimately with the physical suffering of the other, as we do in oncology massage, we offer a gift, emotional and spiritual. We are privileged to weep and hold and look deeply into their eyes, and them into ours.

Thank you for sharing this story. It is beautiful illustration of empathy as contrasting with the more often used sympathy. Brene Brown also illustrates it so beautifully in this short animation. https://vimeo.com/81492863

You took the loneliness out of your patients suffering by feeling with her.

Thank you Robin for another moving story of caring and compassion.
I work in primary health in a peer specialist role alongside health professionals (mainly psychologists) and other peers, supporting people with multiple long-term conditions and frequent admissions to hospital. On one of my first home visits, this lady’s medical notes stated something along the lines of being non-compliant, difficult and unwilling to connect. When 3 of us (2 peers and a psychologist) visited with her in her home, after a short while, the lady shared with us that 2 of her children drowned when they were young. There was no record of this in her medical file. When we left and got into the car, my fellow peer – a mum and grandmother – burst into tears. The first thing she did was to apologise for being emotional.
What we found when we met and talked with this lady (our first visit with her), was that by enabling and encouraging her to share with us what mattered most to her and for us to be empathetic listeners opened up important things to her and this was the start of her recovery.

Having been in this exact situation … delivering a full term baby that has died I have great empathy and great love for who you be in your kindness and willingness to be present in all situations. I was well cared for but there was not the same degree of intimacy aligned with specialist action. Bless you for being with this lady and for all of us here…for while we may not commune all the time we each are crafting our own deliverance of humanity… to humanity! The recognition ….ie re-cognition….is our gift to each other !

A heartfelt tale. And so true. As doctors we are very good &/or well conditioned to leave our emotions aside which sometimes serves us and our patients poorly. I am exploring doctors’ personal grief stories at docgrief.wordpress.com and would value further input and feedback.

As a patient, I want to thank you Robin for having the courage to care so fully in an environment that fears the human vulnerability it encounters every day. Thank you to those who gave you and the OR staff the rest of the day off for the compassion it took to recognize the need to care for the carer. Thank you to the grieving mother for acknowledging and appreciating your compassion, even as she grieved. And thank you to everyone here, who, in their response to this story, support and encourage compassionate care.

Thank you for this very moving account Robin. I so admire you, and all health professionals who can do this work and maintain their human-ness.

Sadly this ‘over-professionalized’ culture transcends medicine. As a young physiotherapy student I was ‘written up’ by my supervisor for becoming “to close” to my patients. I still vividly recall this, yet it happened 35 years ago. I had been working for a number of weeks with a patient who had suffered a stroke. The hospital was in a city, and she lived in a remote area meaning her family was not able to visit. We became close.

One day she received some bad news from her physician, related to her prognosis. She was weeping as she shared this news with me. My offence was to hug her, and have some tears well up as I tried to comfort her. I too recognize that health professionals cannot be crying all the time, but once we cease to show any human emotion – what have we become?

Thank you Robin for sharing this sad yet beautiful story. Curing or fixing involves the body. Healing is about the heart and soul – sharing our common humanity in the midst of grief and anguish, is often not only discouraged, but rarely spoken of. Connecting with our humanity doesn’t in anyway diminish our capacity to be professional and competent. Thank you for sharing a beautiful story that emphasises the healer’s touch – the meeting of hearts as well as minds. We can professionally ‘do the job’ – and – we can bring compassion, humanity and the whole of ourselves to this precious encounter.

This brought tears to my eyes…..a difficult and delicate time for the patient and family. A doctor who realized this and instead of hiding behind medical professionalism; was kind, caring, and compassionate and professional at the same time!
Healthcare needs more of this; physician and social worker in one!
Thanks for writing this story—we need more like you out there. Rules are needed, but sometimes rules are meant to be bent a little 🙂

Lovely and moving story. The idea of staying entirely removed from patient’s troubles is not possible in practice, normal human empathy will move us to comfort a patient when appropriate and welcomed. As a GP, a lot of my job is sympathising with troubles that neither I nor anyone else can alter – the mere feeling that they have been heard can alleviate some of the burden for patients.

I have encountered a similar case just two days ago.
And I was ordered by my senior to stay away and detached as much as possible.
I feel conflicted on daily basis about how much I should get involved with my patients. What I want to do is not always what my seniors wants me to do.
I’m very thankful for your article. It couldn’t come at a better time.

Be compassionate to your seniors. When they react in this way it’s just a sign of their psychological defence and a deep vulnerability hidden inside. They too began medicine with ideals of compassionate caring but have been brutalised by the system. If you want a moving story to share with your department, try this powerful short video, it would stimulate a lot of helpful discussion: https://www.youtube.com/watch?v=TFHP7WbICro

Dear Robin, Thank you for this beautiful story of human vulnerability … for the mother and family losing their precious baby, for your sadness and humanness, and for the explicit acknowledgement to the OR staff that this was a significant experience and their feelings matter as well. I am moved as always by your compassion for those who actively resist being vulnerable in the care of their patients. Rather than judgment … you ask to extend compassion. If we could hold that central in all of our relationships, the world would shift in miraculous ways. Blessings.

Thanks Robin for sharing. There are many obvious pluses to take from this shared story but I was heartened to read that the “OR staff were sent home early, before the end of their shift” and you say “I was relieved of my duties for the rest of the day.” This show of compassion to colleagues is not always evident and to be applauded.

Very moving story of a horrible situation handled with compassion.
I think that the old ideas of not showing emotion with patients are going . In medicine sometimes the only thing we can offer is ourselves, our empathy and humanity.